Viagra

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Viagra is a preparation prescribed for erectile dysfunction treatment.

Pharmachologic effect

Viagra – a drug for the treatment of erectile dysfunction. It acts on the natural mechanisms of erection. It is used in men suffering from erectile dysfunction of various origins (vascular, nervous erection disorders).

Sildenafil is a potent and selective inhibitor of cGMP-specific type 5 phosphodiesterase (PDE5).

The physiological mechanism of penile erection involves the release of nitric oxide (NO) in the cavernous body during sexual stimulation.

Nitric oxide activates the enzyme guanylate cyclase, which contributes to an increase in the level of cyclic guanosine monophosphate (cGMP), relaxation of the smooth muscles of the cavernous body and increased blood flow in the penis.

Sildenafil does not have a direct relaxing effect on an isolated cavernous body, but it actively enhances the relaxing effect of NO on this tissue by inhibiting PDE5, which is responsible for the breakdown of cGMP in the cavernous body.

With sexual excitement, the local release of NO under the influence of sildenafil results in the inhibition of PDE5 and an increase in cGMP in the cavernous body. Finally, it contributes to the relaxation of smooth muscles and increased blood flow in the cavernous body.

The main condition for the effectiveness of sildenafil is sexual stimulation.

Indications

Treatment of erectile dysfunction characterized by an inability to achieve or maintain an erection sufficient for satisfactory intercourse. Viagra is effective only in the presence of sexual stimulation.

Contraindications

  • Hypersensitivity to any component of the drug;
  • Use in patients receiving continuously or intermittently nitric oxide donors, organic nitrates or nitrites in any form;
  • Age under 18 years old;
  • Not intended for use in women.

Take the drug with caution in the following cases:

  • anatomical penile deformation (including angulation, cavernous fibrosis or Peyronie disease);
  • diseases predisposing to the development of priapism (such as sickle cell anemia, multiple myeloma, leukemia, thrombocythemia);
  • diseases accompanied by bleeding;
  • exacerbation of ulcer diseases;
  • hereditary retinitis pigmentosa;
  • heart failure;
  • unstable angina pectoris;
  • myocardial infarction;
  • stroke or life-threatening arrhythmias;
  • arterial hypertension;
  • hypotension.

Dosage and administration

The drug is taken orally. For most patients, the recommended dose is 50 mg; the drug is taken, if necessary, about 1 hour before sexual intercourse. According to the effectiveness and tolerability, the dose can be increased to 100 mg or reduced to 25 mg. The maximum recommended dose is 100 mg. The maximum recommended frequency of use is 1 time/day.

Side effects

Side effects are usually transient/mild/moderate. The frequency of these reactions increases with the dose increase.

  • Whole-body systems: asthenia, pain, abdominal pain, back pain, infection, flu-like syndrome.
  • Cardiovascular system: vasodilation (a side effect recorded in clinical studies).
  • Digestive system: diarrhea, nausea.
  • Musculoskeletal system: joint pain, muscle pain.
  • Central nervous system and peripheral nervous system: dizziness (a side effect registered in clinical trials), increased muscle tone, insomnia.
  • Respiratory system: nasal congestion, pharyngitis, rhinitis (a side effect recorded in clinical trials), sinusitis, respiratory tract infections, respiratory failure.
  • Dermatological reactions: rash.
  • Sensory organs: change in a vision: slight and transient, mainly a change in the color of objects, as well as the increased perception of light and blurred vision, conjunctivitis.
  • Urinary system: urinary tract infections.
  • Reproductive system: impaired prostate function.

Interactions

  • Use in patients taking continuously or intermittently nitric oxide donors, organic nitrates or nitrites in any form, since sildenafil enhances the hypotensive effect of nitrates (see section “Interaction with other drugs”).
  • The combined use of PDE5 inhibitors, including sildenafil, with guanylate cyclase stimulants as it can result in symptomatic hypotension.
  • The safety and efficacy of Viagra, when used together with other treatments for erectile dysfunction, have not been studied, therefore the use of such combinations is not recommended.
  • Concomitant use of ritonavir.

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